Examines how 2010 reform provisions limit coverage options for noncitizens and may deter immigrant parents from enrolling citizen children and how the exclusion of uninsured children in immigrant families may affect community clinics and public hospitals

Livier Cabezas

Ninez Ponce

Shana Alex Lavarreda

English

IssueLab

Health Policy BriefJune 2011Support for this policy brief wasprovided by grants fromThe California Endowment andThe California Wellness Foundation.S UMMARY: The Patient Protection andAffordable Care Act of 2010 (ACA) restricts itshealth insurance expansions in ways that excludemany uninsured children in California whoare immigrants or have immigrant parents.These exclusions directly limit coverageoptions for noncitizen children. And immigrantparents, potentially misinterpreting eligibilityrequirements for these new programs, maynot enroll their citizen children. Using the 2007California Health Interview Survey (CHIS 2007),this policy brief estimates that of the 1.08 millionhe Patient Protection and AffordableCare Act (ACA) of 2010 expandscoverage for Californians overall, but leavesout a segment of immigrant families, manyof whom are legal residents. Under ACA,households with incomes up to 133% of theFederal Poverty Level (FPL) will becomeeligible for Medicaid, regardless of whetherthere are dependent children. Uninsuredpersons with incomes between 134% and400% FPL will be eligible for federalsubsidies that will help them purchaseprivate insurance within the new state-basedExchange health insurance marketplaces.However, U.S. citizenship and residencystatus requirements impact immigrantfamilies’ access to ACA coverage expansionsin two ways. First, undocumented immigrantsare barred from purchasing coverage in thestate Exchanges, even if purchasing entirelywith their own money. Undocumentedimmigrants will be able to purchase privateinsurance outside of the Exchange, but wouldnot benefit from the protections or competitiveprices of insurance products in the Exchange.According to the 2007 California HealthInterview Survey (CHIS 2007), the ACAexclusions will have a direct effect on 30,000children in California who were uninsuredduring the past 12 months and werenoncitizens without a green card (the closestproxy in CHIS 2007 for undocumented status),living in households with incomes between134-400% FPL (Exhibit 1).1 These immigrantchildren would not be allowed to gain coveragethrough the Exchange.Second, there will be no federal funding forenrolling either undocumented immigrantsor legal immigrants who have lived in theU.S. for fewer than five years in the state’snewly expanded Medicaid program. In 2007,140,000 uninsured children were noncitizenswith no green card living in households withchildren in California who were uninsured all orpart of the year, between 180,000 to 220,000will be excluded from the health care reformexpansions due to the combined direct andpotential indirect effects of these exclusions.This "left-out" group comprises between 17%and 20% of all uninsured children in California.In light of these exclusions, California’scommunity clinics and public hospitals couldcontinue to serve a significant number ofuninsured immigrant children even after fullimplementation of ACA.TThe Impact of Health Care Reform onCalifornia’s Children in Immigrant FamiliesNinez Ponce, Shana Alex Lavarreda and Livier Cabezas‘‘Up to 220,000immigrantchildren maybe left out ofhealth carereform.‘‘UCLA CENTER FOR HEALTH POLICY RESEARCHExhibit 1 Impact of ACA Citizenship and Residency Restrictions among Children in ImmigrantFamilies Who Were Uninsured During the Past 12 Months, Ages 0-18, California, 20072incomes less than 134% FPL. These childrenwould be directly excluded from the ACA-funded Medi-Cal expansion (Exhibit 1). An estimated additional 10,000 childrenwith household incomes at less than 134%FPL were legal immigrants in the U.S. fewerthan five years (Exhibit 1), and wouldtherefore not be funded through federal dollarsfor the Medi-Cal expansion. Historically,California has used state dollars to fundMedi-Cal coverage for this population.However, as the state budget has becomemore strained in recent years, eliminatingthis funding has been raised repeatedly as apotential source of revenue (see Discussion). In total, an estimated 180,000 uninsuredchildren will be excluded from the ACAcoverage expansions because of their owncitizenship status (Exhibit 1). An estimated additional 40,000 children whowere uninsured all or part of the past yearwould be potentially excluded from the ACAcoverage expansions due to their parent’scitizenship status. There could be an indirecteffect when parents who are noncitizenswithout a green card, who are themselvesexcluded from public programs and theExchange, may perceive that thedocumentation restrictions also apply to their qualified citizen children. Combined,the number of directly and potentiallyexcluded uninsured children is a total of220,000, or 20% of all children who wereuninsured all or part of the year in 2007 thatmay be left out of ACA coverage expansions. Community Clinics as Safety Net Given the restrictions in ACA due tocitizenship and residency status, community* Noncitizen with a green card, living in the U.S. fewer thanfive years.** We assumed that approximately 24% of citizen childrenwith noncitizen parents would not enroll in the Medi-Calexpansion based on the current estimate of percent eligiblebut not enrolled in public programs for this group. Since theExchange will be a new program and its eligibility ruleswould more likely be misinterpreted than the Medi-Calexpansion, we made the upper-bound assumption that 100%of citizen children with noncitizen parents would not enrollin the Exchange.Note: All estimates are rounded off to nearest tens of thousands.Source: 2007 California Health Interview SurveyImpact of ACA Citizenship Legal Noncitizen, Totaland Residency Restrictions Permanent Resident* No Green CardDirect Effect: Child’s Citizenship StatusRestricted from Medi-Cal Enrollment 10,000 140,000 150,000Restricted from Exchange Enrollment 30,000 30,000Total Excluded 10,000 170,000 180,000 Indirect Effect: Parent’s Citizenship Status**Potential Restriction from Medi-Cal Enrollment 10,000 10,000Potential Restriction from Exchange Enrollment 30,000 30,000 Total Potentially Excluded 40,000 40,000 Total Directly and Indirectly Impacted 10,000 210,000 220,000‘‘There is likelyto be significantconfusion overeligibility.‘‘3UCLA CENTER FOR HEALTH POLICY RESEARCHExhibit 2Family Immigration Status among Uninsured Children Who Use Community Health Clinicsor Public Hospitals as Their Usual Source of Care, Ages 0-18, California, 2007all uninsured children, regardless ofcitizenship or immigration status. California’s Public Programs CurrentlyProvide Coverage for Immigrant ChildrenMore than 1 million children in immigrantfamilies (1.4 million) had coverage in 2007through California’s public health insuranceprograms (Exhibit 3). Four in ten citizenchildren with legal permanent residentparents are covered by either Medi-Cal orHealthy Families. Three out of four citizen children withnoncitizen parents with no green card arecovered by public programs, offsetting a very low rate of job-based coverage (11.2%;Exhibit 3). Nearly half of legal permanentresident children (44.8%) have publichealth clinics will likely remain a majorsource of preventive and primary care for the remaining uninsured children. Nearlyhalf of children in immigrant families (45%)who were uninsured for all or part of 2007rely on community health clinics as theirusual source of care.Just over one-third of all uninsured children(371,000) used community health clinics as a usual source of care (Exhibit 2). Amongthese, citizen children with citizen parentsare the largest group (44.2%), followed bycitizen children with noncitizen parents(17.8% legal permanent resident and 13.7%without a green card), and noncitizenchildren who do not have a green cardthemselves (21%). This demonstrates thevital role community health clinics play forSource:  2007 California Health Interview SurveyNoncitizen withoutGreen Card Child21.0%78,000Noncitizen LegalPermanent Resident Child3.2%12,000Citizen Child ofNoncitizen without Green Card Parents13.7%51,000Citizen Child with LegalPermanent Resident Parents17.8%66,000Citizen Child withCitizen Parents44.2%164,000Number of Uninsured Children Using  Community Health Clinics as a Usual Source of Care = 371,000‘‘Communityclinics willcontinue to play a vital role servinguninsuredchildren.‘‘4UCLA CENTER FOR HEALTH POLICY RESEARCHExhibit 3Health Insurance Coverage by Family Citizenship Status among Children in ImmigrantFamilies, Ages 0-18, California, 2007coverage, and 32.7% of noncitizen childrenwithout their own green card can accesspublic coverage.2 These current estimates on enrollment in public programs indicatethat a sizeable proportion of noncitizenparents without green cards would enrolltheir children in public coverage programs if they were eligible. It is uncertain whetherthis would translate to overcoming barriers tofuture enrollment in the Exchange.DiscussionCurrent public programs are already providinga safety net to citizen children with noncitizenparents that do not have a green card (overthree-fourths have public coverage), but theACA excludes their parents from enrolling in public insurance expansions and frompurchasing in the new Exchange. Noncitizenchildren without a green card will also be leftout of the ACA expansions, with limitedpublic coverage funded entirely through statefunds that may dry up, given the state’s budgetcrisis. With the combination of both thedirect and potential indirect effects of ACArestrictions on coverage expansions and theCalifornia budget crisis, citizen children ofnoncitizen parents and noncitizen childrenalike may face barriers to gaining coverage.ACA continues the federal government’scurrent policy of not funding public coveragefor noncitizen legal permanent residentchildren that have lived in the U.S. for fewerthan five years. This provision will extend totheir parents as well under the new Medi-Calexpansion. Historically, California has usedstate dollars to fund Medi-Cal coverage for(Continued on page 5)*** Number is statistically unstable because the variation is over 30%.Note: Numbers may not add to 100% due to rounding.Source: 2007 California Health Interview Survey10.1%36,00032.7%117,00048.6%174,00025.5%61,00044.8%107,00020.9%50,00011.2%100,00076.2%680,0008.4%75,000100%90%80%70%60%50%40%30%20%10%0%Citizen Child, Noncitizen LegalPermanent ResidentParentsCitizen Child,Noncitizen Parents with No Green Card38.4%463,000Noncitizen LegalPermanent Resident ChildNoncitizen Childwith No Green CardUninsured All or Part YearOtherAll YearPrivatelyPurchasedAll YearMedi-Cal orHealthy FamiliesAll Year40.8%492,0003.6%43,0004.3%52,00013.0%157,0003.6%32,000******5.9%14,0003.6%13,0005.0%18,000Employment-BasedInsurance All Year‘‘California’sbudget crisismay reducepublic coverageoptions.‘‘5 UCLA CENTER FOR HEALTH POLICY RESEARCHthis population. However, as the state budgethas become more strained in recent years,eliminating this funding has been raisedrepeatedly as a potential source of revenue.Additionally, if California opts for fundingthe Medicaid expansion for the newly-eligiblepopulation with federal funds only, citizensand legal permanent residents who have livedin the U.S. for five years or more will be theonly ones who qualify.In addition, as of 2014, legal permanentresidents who have lived in the U.S. for fewerthan five years will become eligible forsubsidies to purchase insurance through theExchange. But, if the proposed state fundingcuts occur before the Exchange becomesoperational, 98,000 noncitizen children whocurrently have Medi-Cal and have lived in theU.S. fewer than five years (data not shown)would find themselves uninsured.Finally, 55.8% of uninsured children who usecommunity health clinics and public hospitalsas their usual source of care are immigrantchildren or in families with mixed immigrationstatus. These could include large segments ofthe 180,000 to 220,000 children that willface barriers to getting health insurance evenafter the full implementation of ACA, andmay remain uninsured. ACA provisions docontain funding directly for community healthcenters, in an attempt to reimburse themfor their continued work in caring for theuninsured. However, proposed legislation inthe current U.S. House of Representativesthreatens to cut $600 million for communityhealth centers.3 If this legislation is enacted,it will immediately cut funding to communityhealth clinics from $1 billion to $400 million,affecting over 5 million people that alreadyuse these clinics as a usual source of care.Funding these community-based providers atboth the federal and state levels is of vitalimportance for maintenance of their ability todeliver health care to immigrant children leftout of health care reform.Data SourceThis policy brief reports data from the 2007California Health Interview Survey (CHIS 2007).For more information on CHIS 2007, please seewww.chis.ucla.edu.Author InformationNinez Ponce, PhD, MPP, is associate professor at theUCLA School of Public Health in the Departmentof Health Services and senior research scientist at theUCLA Center for Health Policy Research; ShanaAlex Lavarreda, PhD, MPP, is director of HealthInsurance Studies and research scientist at the UCLACenter for Health Policy Research; Livier Cabezas,MPAff, is project manager of the State of HealthInsurance in California Project at the UCLA Centerfor Health Policy Research.AcknowledgementsThe authors would like to thank Peggy Kan for herprogramming support. We also thank E. RichardBrown, Nadereh Pourat and Steve Wallace for theirthoughtful reviews and insights.Funding InformationThis policy brief was developed with grants fromThe California Endowment and The CaliforniaWellness Foundation.Suggested CitationPonce N, Lavarreda SA and Cabezas L. The Impactof Health Care Reform on California’s Children inImmigrant Families. Los Angeles, CA: UCLA Centerfor Health Policy Research, 2011.Endnotes1 The California Health Interview Survey asks whether ornot a child is a citizen and whether they have a greencard, as well as length of residency in the U.S. “Noncitizenwithout a green card” is therefore the closest proxy groupfor undocumented immigrants.2 This coverage is limited to emergency Medi-Cal withreduced benefits and may be misreported as coveragewhen receiving services from community health clinicsand hospitals.3 National Association of Community Health Centers(2011). “MACHC Statement on the Recently ReleasedBudget Deal” April 12, 2011. http://sgahealth.com/news/2010-budget-cuts-600-million-from-fqhcs/.This publication containsdata from the CaliforniaHealth Interview Survey(CHIS), the nation’s largeststate health survey.Conducted by the UCLACenter for Health PolicyResearch, CHIS data givesa detailed picture of thehealth and health careneeds of California’s largeand diverse population.Learn more at:www.chis.ucla.eduUCLA CENTER FOR HEALTH POLICY RESEARCH10960 Wilshire Blvd., Suite 1550Los Angeles, California 90024The views expressed in this policy briefare those of the authors and do notnecessarily represent the UCLA Center forHealth Policy Research, the Regents of theUniversity of California, or collaboratingorganizations or funders.PB2011-8Copyright © 2011 by the Regents of theUniversity of California. All Rights Reserved.Editor-in-Chief: E. Richard Brown, PhDThe UCLA Centerfor Health Policy Researchis affiliated with theUCLA School of Public Healthand the UCLA School of Public Affairs.Phone: 310-794-0909Fax: 310-794-2686Email: chpr@ucla.eduwww.healthpolicy.ucla.eduFirst ClassMailU.S. PostagePAIDUCLARead this publication online

The Impact of Health Care Reform on California's Children in Immigrant Families

The Patient Protection and Affordable Care Act of 2010 (ACA) restricts its health insurance expansions in ways that exclude many uninsured children in California who are immigrants or have immigrant parents. These exclusions directly limit coverage options for noncitizen children. And immigrant parents, potentially misinterpreting eligibility requirements for these new programs, may not enroll their citizen children. Using the 2007 California Health Interview Survey (CHIS 2007), this policy brief estimates that of the 1.08 million children in California who were uninsured all or part of the year, between 180,000 to 220,000 will be excluded from the health care reform expansions due to the combined direct and potential indirect effects of these exclusions. This "left-out" group comprises between 17% and 20% of all uninsured children in California. In light of these exclusions, California’s community clinics and public hospitals could continue to serve a significant number of uninsured immigrant children even after full implementation of ACA

Ponce, Ninez

Lavarreda, Shana A

Cabezas, Livier

eScholarship - University of California

UCLARecent WorkTitleThe Impact of Health Care Reform on California’s Children in Immigrant FamiliesPermalinkhttps://escholarship.org/uc/item/3mp0f3n3AuthorsPonce, NinezLavarreda, Shana ACabezas, LivierPublication Date2011-06-30 Peer reviewedeScholarship.org Powered by the California Digital LibraryUniversity of CaliforniaHealth Policy BriefJune 2011Support for this policy brief wasprovided by grants fromThe California Endowment andThe California Wellness Foundation.S UMMARY: The Patient Protection andAffordable Care Act of 2010 (ACA) restricts itshealth insurance expansions in ways that excludemany uninsured children in California whoare immigrants or have immigrant parents.These exclusions directly limit coverageoptions for noncitizen children. And immigrantparents, potentially misinterpreting eligibilityrequirements for these new programs, maynot enroll their citizen children. Using the 2007California Health Interview Survey (CHIS 2007),this policy brief estimates that of the 1.08 millionhe Patient Protection and AffordableCare Act (ACA) of 2010 expandscoverage for Californians overall, but leavesout a segment of immigrant families, manyof whom are legal residents. Under ACA,households with incomes up to 133% of theFederal Poverty Level (FPL) will becomeeligible for Medicaid, regardless of whetherthere are dependent children. Uninsuredpersons with incomes between 134% and400% FPL will be eligible for federalsubsidies that will help them purchaseprivate insurance within the new state-basedExchange health insurance marketplaces.However, U.S. citizenship and residencystatus requirements impact immigrantfamilies’ access to ACA coverage expansionsin two ways. First, undocumented immigrantsare barred from purchasing coverage in thestate Exchanges, even if purchasing entirelywith their own money. Undocumentedimmigrants will be able to purchase privateinsurance outside of the Exchange, but wouldnot benefit from the protections or competitiveprices of insurance products in the Exchange.According to the 2007 California HealthInterview Survey (CHIS 2007), the ACAexclusions will have a direct effect on 30,000children in California who were uninsuredduring the past 12 months and werenoncitizens without a green card (the closestproxy in CHIS 2007 for undocumented status),living in households with incomes between134-400% FPL (Exhibit 1).1 These immigrantchildren would not be allowed to gain coveragethrough the Exchange.Second, there will be no federal funding forenrolling either undocumented immigrantsor legal immigrants who have lived in theU.S. for fewer than five years in the state’snewly expanded Medicaid program. In 2007,140,000 uninsured children were noncitizenswith no green card living in households withchildren in California who were uninsured all orpart of the year, between 180,000 to 220,000will be excluded from the health care reformexpansions due to the combined direct andpotential indirect effects of these exclusions.This "left-out" group comprises between 17%and 20% of all uninsured children in California.In light of these exclusions, California’scommunity clinics and public hospitals couldcontinue to serve a significant number ofuninsured immigrant children even after fullimplementation of ACA.TThe Impact of Health Care Reform onCalifornia’s Children in Immigrant FamiliesNinez Ponce, Shana Alex Lavarreda and Livier Cabezas‘‘Up to 220,000immigrantchildren maybe left out ofhealth carereform.‘‘UCLA CENTER FOR HEALTH POLICY RESEARCHExhibit 1 Impact of ACA Citizenship and Residency Restrictions among Children in ImmigrantFamilies Who Were Uninsured During the Past 12 Months, Ages 0-18, California, 20072incomes less than 134% FPL. These childrenwould be directly excluded from the ACA-funded Medi-Cal expansion (Exhibit 1). An estimated additional 10,000 childrenwith household incomes at less than 134%FPL were legal immigrants in the U.S. fewerthan five years (Exhibit 1), and wouldtherefore not be funded through federal dollarsfor the Medi-Cal expansion. Historically,California has used state dollars to fundMedi-Cal coverage for this population.However, as the state budget has becomemore strained in recent years, eliminatingthis funding has been raised repeatedly as apotential source of revenue (see Discussion). In total, an estimated 180,000 uninsuredchildren will be excluded from the ACAcoverage expansions because of their owncitizenship status (Exhibit 1). An estimated additional 40,000 children whowere uninsured all or part of the past yearwould be potentially excluded from the ACAcoverage expansions due to their parent’scitizenship status. There could be an indirecteffect when parents who are noncitizenswithout a green card, who are themselvesexcluded from public programs and theExchange, may perceive that thedocumentation restrictions also apply to their qualified citizen children. Combined,the number of directly and potentiallyexcluded uninsured children is a total of220,000, or 20% of all children who wereuninsured all or part of the year in 2007 thatmay be left out of ACA coverage expansions. Community Clinics as Safety Net Given the restrictions in ACA due tocitizenship and residency status, community* Noncitizen with a green card, living in the U.S. fewer thanfive years.** We assumed that approximately 24% of citizen childrenwith noncitizen parents would not enroll in the Medi-Calexpansion based on the current estimate of percent eligiblebut not enrolled in public programs for this group. Since theExchange will be a new program and its eligibility ruleswould more likely be misinterpreted than the Medi-Calexpansion, we made the upper-bound assumption that 100%of citizen children with noncitizen parents would not enrollin the Exchange.Note: All estimates are rounded off to nearest tens of thousands.Source: 2007 California Health Interview SurveyImpact of ACA Citizenship Legal Noncitizen, Totaland Residency Restrictions Permanent Resident* No Green CardDirect Effect: Child’s Citizenship StatusRestricted from Medi-Cal Enrollment 10,000 140,000 150,000Restricted from Exchange Enrollment 30,000 30,000Total Excluded 10,000 170,000 180,000 Indirect Effect: Parent’s Citizenship Status**Potential Restriction from Medi-Cal Enrollment 10,000 10,000Potential Restriction from Exchange Enrollment 30,000 30,000 Total Potentially Excluded 40,000 40,000 Total Directly and Indirectly Impacted 10,000 210,000 220,000‘‘There is likelyto be significantconfusion overeligibility.‘‘3UCLA CENTER FOR HEALTH POLICY RESEARCHExhibit 2Family Immigration Status among Uninsured Children Who Use Community Health Clinicsor Public Hospitals as Their Usual Source of Care, Ages 0-18, California, 2007all uninsured children, regardless ofcitizenship or immigration status. California’s Public Programs CurrentlyProvide Coverage for Immigrant ChildrenMore than 1 million children in immigrantfamilies (1.4 million) had coverage in 2007through California’s public health insuranceprograms (Exhibit 3). Four in ten citizenchildren with legal permanent residentparents are covered by either Medi-Cal orHealthy Families. Three out of four citizen children withnoncitizen parents with no green card arecovered by public programs, offsetting a very low rate of job-based coverage (11.2%;Exhibit 3). Nearly half of legal permanentresident children (44.8%) have publichealth clinics will likely remain a majorsource of preventive and primary care for the remaining uninsured children. Nearlyhalf of children in immigrant families (45%)who were uninsured for all or part of 2007rely on community health clinics as theirusual source of care.Just over one-third of all uninsured children(371,000) used community health clinics as a usual source of care (Exhibit 2). Amongthese, citizen children with citizen parentsare the largest group (44.2%), followed bycitizen children with noncitizen parents(17.8% legal permanent resident and 13.7%without a green card), and noncitizenchildren who do not have a green cardthemselves (21%). This demonstrates thevital role community health clinics play forSource:  2007 California Health Interview SurveyNoncitizen withoutGreen Card Child21.0%78,000Noncitizen LegalPermanent Resident Child3.2%12,000Citizen Child ofNoncitizen without Green Card Parents13.7%51,000Citizen Child with LegalPermanent Resident Parents17.8%66,000Citizen Child withCitizen Parents44.2%164,000Number of Uninsured Children Using  Community Health Clinics as a Usual Source of Care = 371,000‘‘Communityclinics willcontinue to play a vital role servinguninsuredchildren.‘‘4UCLA CENTER FOR HEALTH POLICY RESEARCHExhibit 3Health Insurance Coverage by Family Citizenship Status among Children in ImmigrantFamilies, Ages 0-18, California, 2007coverage, and 32.7% of noncitizen childrenwithout their own green card can accesspublic coverage.2 These current estimates on enrollment in public programs indicatethat a sizeable proportion of noncitizenparents without green cards would enrolltheir children in public coverage programs if they were eligible. It is uncertain whetherthis would translate to overcoming barriers tofuture enrollment in the Exchange.DiscussionCurrent public programs are already providinga safety net to citizen children with noncitizenparents that do not have a green card (overthree-fourths have public coverage), but theACA excludes their parents from enrolling in public insurance expansions and frompurchasing in the new Exchange. Noncitizenchildren without a green card will also be leftout of the ACA expansions, with limitedpublic coverage funded entirely through statefunds that may dry up, given the state’s budgetcrisis. With the combination of both thedirect and potential indirect effects of ACArestrictions on coverage expansions and theCalifornia budget crisis, citizen children ofnoncitizen parents and noncitizen childrenalike may face barriers to gaining coverage.ACA continues the federal government’scurrent policy of not funding public coveragefor noncitizen legal permanent residentchildren that have lived in the U.S. for fewerthan five years. This provision will extend totheir parents as well under the new Medi-Calexpansion. Historically, California has usedstate dollars to fund Medi-Cal coverage for(Continued on page 5)*** Number is statistically unstable because the variation is over 30%.Note: Numbers may not add to 100% due to rounding.Source: 2007 California Health Interview Survey10.1%36,00032.7%117,00048.6%174,00025.5%61,00044.8%107,00020.9%50,00011.2%100,00076.2%680,0008.4%75,000100%90%80%70%60%50%40%30%20%10%0%Citizen Child, Noncitizen LegalPermanent ResidentParentsCitizen Child,Noncitizen Parents with No Green Card38.4%463,000Noncitizen LegalPermanent Resident ChildNoncitizen Childwith No Green CardUninsured All or Part YearOtherAll YearPrivatelyPurchasedAll YearMedi-Cal orHealthy FamiliesAll Year40.8%492,0003.6%43,0004.3%52,00013.0%157,0003.6%32,000******5.9%14,0003.6%13,0005.0%18,000Employment-BasedInsurance All Year‘‘California’sbudget crisismay reducepublic coverageoptions.‘‘5 UCLA CENTER FOR HEALTH POLICY RESEARCHthis population. However, as the state budgethas become more strained in recent years,eliminating this funding has been raisedrepeatedly as a potential source of revenue.Additionally, if California opts for fundingthe Medicaid expansion for the newly-eligiblepopulation with federal funds only, citizensand legal permanent residents who have livedin the U.S. for five years or more will be theonly ones who qualify.In addition, as of 2014, legal permanentresidents who have lived in the U.S. for fewerthan five years will become eligible forsubsidies to purchase insurance through theExchange. But, if the proposed state fundingcuts occur before the Exchange becomesoperational, 98,000 noncitizen children whocurrently have Medi-Cal and have lived in theU.S. fewer than five years (data not shown)would find themselves uninsured.Finally, 55.8% of uninsured children who usecommunity health clinics and public hospitalsas their usual source of care are immigrantchildren or in families with mixed immigrationstatus. These could include large segments ofthe 180,000 to 220,000 children that willface barriers to getting health insurance evenafter the full implementation of ACA, andmay remain uninsured. ACA provisions docontain funding directly for community healthcenters, in an attempt to reimburse themfor their continued work in caring for theuninsured. However, proposed legislation inthe current U.S. House of Representativesthreatens to cut $600 million for communityhealth centers.3 If this legislation is enacted,it will immediately cut funding to communityhealth clinics from $1 billion to $400 million,affecting over 5 million people that alreadyuse these clinics as a usual source of care.Funding these community-based providers atboth the federal and state levels is of vitalimportance for maintenance of their ability todeliver health care to immigrant children leftout of health care reform.Data SourceThis policy brief reports data from the 2007California Health Interview Survey (CHIS 2007).For more information on CHIS 2007, please seewww.chis.ucla.edu.Author InformationNinez Ponce, PhD, MPP, is associate professor at theUCLA School of Public Health in the Departmentof Health Services and senior research scientist at theUCLA Center for Health Policy Research; ShanaAlex Lavarreda, PhD, MPP, is director of HealthInsurance Studies and research scientist at the UCLACenter for Health Policy Research; Livier Cabezas,MPAff, is project manager of the State of HealthInsurance in California Project at the UCLA Centerfor Health Policy Research.AcknowledgementsThe authors would like to thank Peggy Kan for herprogramming support. We also thank E. RichardBrown, Nadereh Pourat and Steve Wallace for theirthoughtful reviews and insights.Funding InformationThis policy brief was developed with grants fromThe California Endowment and The CaliforniaWellness Foundation.Suggested CitationPonce N, Lavarreda SA and Cabezas L. The Impactof Health Care Reform on California’s Children inImmigrant Families. Los Angeles, CA: UCLA Centerfor Health Policy Research, 2011.Endnotes1 The California Health Interview Survey asks whether ornot a child is a citizen and whether they have a greencard, as well as length of residency in the U.S. “Noncitizenwithout a green card” is therefore the closest proxy groupfor undocumented immigrants.2 This coverage is limited to emergency Medi-Cal withreduced benefits and may be misreported as coveragewhen receiving services from community health clinicsand hospitals.3 National Association of Community Health Centers(2011). “MACHC Statement on the Recently ReleasedBudget Deal” April 12, 2011. http://sgahealth.com/news/2010-budget-cuts-600-million-from-fqhcs/.This publication containsdata from the CaliforniaHealth Interview Survey(CHIS), the nation’s largeststate health survey.Conducted by the UCLACenter for Health PolicyResearch, CHIS data givesa detailed picture of thehealth and health careneeds of California’s largeand diverse population.Learn more at:www.chis.ucla.eduUCLA CENTER FOR HEALTH POLICY RESEARCH10960 Wilshire Blvd., Suite 1550Los Angeles, California 90024The views expressed in this policy briefare those of the authors and do notnecessarily represent the UCLA Center forHealth Policy Research, the Regents of theUniversity of California, or collaboratingorganizations or funders.PB2011-8Copyright © 2011 by the Regents of theUniversity of California. All Rights Reserved.Editor-in-Chief: E. Richard Brown, PhDThe UCLA Centerfor Health Policy Researchis affiliated with theUCLA School of Public Healthand the UCLA School of Public Affairs.Phone: 310-794-0909Fax: 310-794-2686Email: chpr@ucla.eduwww.healthpolicy.ucla.eduFirst ClassMailU.S. PostagePAIDUCLARead this publication online

The Impact of Health Care Reform on California’s Children in Immigrant Families

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The Impact of Health Care Reform on California's Children in Immigrant Families

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